Summary
Overview
Work History
Education
Skills
Accomplishments
Additional Qualifications
Timeline
Generic

Teresa Hayes

League City,TX

Summary

Medical Services Professional with over 20 years of credentialing experience in military, hospital, and ambulatory surgery centers in roles ranging from Credentialing Clerk to Medical Staff Coordinator. Passion, dedication, and drive to help ensure quality care, patient safety, and integrity are maintained through meticulous and diligent credentialing, re-credentialing, and privileging. Medical Services Professional Skills Summary Initial and Reappointments Graduate Medical Education (GME) coordination in non-profit and teaching institutions. Onboarding initial providers and terming providers from staff Focused Professional Practice Evaluation (FPPE)/Ongoing Professional Practice Evaluation (OPPE) Monitoring Credentialing software – Echo, Cactus, MD-Staff, Midas, and Sales Force Health Plan Enrollment – Medicaid, Aetna, Humana, Medicare Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

12
12
years of professional experience

Work History

Asst. Account Manager

PPS
Jacksonville
02.2024 - Current
  • Managed CAQH Credentialing and Medicare Enrollment.
  • Provided Credentialing Maintenance Services.
  • Assisted with Onboarding of new practice groups.
  • Responded promptly to emails from customers concerning account status updates or product questions.
  • Updated internal databases with current contact information for all key contacts within each account.

Credentialing Coordinator

Caris Life Sciences
Irving
03.2021 - 01.2024
  • Streamlined processes and workflows using automation.
  • Developed and implemented credentialing processes and procedures.
  • Assisted the legal department with contract processing and queries.

Medical Services Professional Contractor

The Hardenbergh Group
Livonia, Michigan
09.2021 - 10.2023
  • Qualified to perform a range of duties for hospitals located across the United States via telecommuting
  • Responsibilities include processing applications for appointments, reappointments, taking meeting attendance, reviews applications for completeness
  • Provide excellent customer service to medical staff and personnel
  • Follow regulatory agencies such as TJC, NCQA, and AAAHC
  • Health Plan Enrollment

Credentialing Specialist Contractor

Molina Healthcare
San Antonio, Texas
03.2021 - 08.2021
  • Prepared files for the credentialing committee via TJC requirements
  • Coordinated with the network team to review and approve cred documentation
  • Ongoing monitoring of providers in the network for items such as sanctions and license revocations
  • Oversight of re-credentialing process and termination of providers who fell out of compliance
  • Reviewed and approved providers for expedited credentialing in alignment with Texas insurance and administration codes
  • Aligned with the provider data load team to ensure congruence in the contract to in-network process.

Credentials Coordinator

MD Anderson
Houston, Texas
05.2019 - 02.2021
  • Processed credentialing of providers according to institutional and regulatory standards by conducting primary source verification and outside agency queries
  • Performed data entry related to initial credentialing, re-credentialing, additional privileges, modification of privileges, change of departmental assignment or other credentialing/privileging activities
  • Entered data in practitioner's profile in database record related to credentialing activities
  • Provided administrative support for assigned Medical Staff Committees of the Medical Staff
  • Served as Departmental Liaison
  • Served as Medical Staff Office liaison to administrative support staff and providers associated with the clinical department for coordinating credentialing of potential candidates and re-credentialing for clinical staff regarding membership or privileges
  • Effectively coordinated, integrated, and communicated information and services within the department and with other departments such as practitioner privileges, privileging criteria, and other content surrounding credentialing activities.

Credentialing Coordinator

Shriners Hospital for Children
Galveston, Texas
12.2016 - 06.2018
  • Processed initial and reappointments
  • Tracked and maintained expirables via TJC requirements
  • Credentialed Residents, Fellows, Observers, and Medical Students
  • Communicated necessary changes to UTMB Residency Coordinators as it relates to residents and fellows
  • Provided support to the Chief of Staff, Medical Staff, Committees, Performance Improvement Department, and Education Department
  • Maintained credentials minutes and agendas
  • Presented credential files to the Credentialing Committee monthly
  • Processed Medicare and Medicaid applications and other health plans
  • Utilized MDStaff
  • Maintains credentialing and OPPE/FPPE in MDStaff database
  • Audited and maintained credentials files onsite
  • Prepared credentialing reports
  • Assisted in developing policies and procedures to support the organization including streamlined resident credentialing process.

Credentialing Specialist

HCA Gulf Coast Ambulatory Surgery Division
Houston, Texas
02.2013 - 03.2016
  • Processed initial credentialing and recredentialing
  • Tracked and maintained expirables
  • Promoted quality patient care and customer service/satisfaction
  • Accomplishments: Created the first palliative care privileges for Shriner’s Hospital Galveston
  • Second, the entire Air Force to implement Department of Defense credentialing software to be used to credential Air Force Medical Staff globally
  • Devoted many hours entering over 500 medical staff members into the database (CCQAS)
  • Followed AAAHC requirements and NCQA.

Education

Bachelor of Science - Healthcare Administration

University of Phoenix
Tempe, AZ
06-2023

Skills

  • Initial and Reappointments
  • Graduate Medical Education (GME) coordination
  • Onboarding
  • Focused Professional Practice Evaluation (FPPE)/Ongoing Professional Practice Evaluation (OPPE) Monitoring
  • Credentialing software - Echo, Cactus, MD-Staff, Midas, and Sales Force
  • Health Plan Enrollment - Medicaid, Aetna, Humana, Medicare
  • Professionalism
  • Teamwork and Collaboration
  • Time Management
  • Self Motivation
  • Interpersonal Communication

Accomplishments

  • Created the first palliative care privileges for Shriner’s Hospital Galveston.
  • Second, the entire Air Force to implement Department of Defense credentialing software to be used to credential Air Force Medical Staff globally. Devoted many hours entering over 500 medical staff members into the database (CCQAS).
  • Followed AAAHC requirements and NCQA

Additional Qualifications

Echo, MD-Staff, Visual Cactus, MSOW, MSOW E-Delineate Module, Midas, Microsoft Office – Adobe Acrobat, Outlook, Word, PowerPoint, MS Teams, Zoom, WebEx, Excel, University of Phoenix - B.S. Health Administration, U.S. Air Force

Timeline

Asst. Account Manager

PPS
02.2024 - Current

Medical Services Professional Contractor

The Hardenbergh Group
09.2021 - 10.2023

Credentialing Coordinator

Caris Life Sciences
03.2021 - 01.2024

Credentialing Specialist Contractor

Molina Healthcare
03.2021 - 08.2021

Credentials Coordinator

MD Anderson
05.2019 - 02.2021

Credentialing Coordinator

Shriners Hospital for Children
12.2016 - 06.2018

Credentialing Specialist

HCA Gulf Coast Ambulatory Surgery Division
02.2013 - 03.2016

Bachelor of Science - Healthcare Administration

University of Phoenix
Teresa Hayes